HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: clinchem.2005.050153v1 51/8/1405    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (23) Citing Articles via Google Scholar Google Scholar Articles by Sandri, M. T. Articles by Cipolla, C. M. Search for Related Content PubMed PubMed Citation Articles by Sandri, M. T. Articles by Cipolla, C. M. Related Collections Proteomics and Protein Markers

N-Terminal Pro-B-Type Natriuretic Peptide after High-Dose Chemotherapy: A Marker Predictive of Cardiac Dysfunction?

¹ Laboratory Medicine Unit,² Cardiology Unit,³ Epidemiology and Biostatistics Division, and⁴ Hematoncology Division, European Institute of Oncology, Milan, Italy.

^aAddress correspondence to this author at: Laboratory Medicine Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Fax 39-0257489417; e-mail maria.sandri{at}ieo.it.

Background: Chronic cardiac dysfunction may develop after administration of aggressive chemotherapy, sometimes leading to development of congestive heart failure (CHF). Recently, N-terminal pro-B-type natriuretic peptide (NT-proBNP) was implicated as a marker of CHF. In this study we evaluated the predictive role of NT-proBNP in patients treated with high-dose chemotherapy (HDC).

Methods: NT-proBNP was measured after 62 chemotherapy treatments in 52 patients affected by aggressive malignancies. Blood samples were drawn before the start of HDC, at the end of HDC administration, and 12, 24, 36, and 72 h thereafter. In these patients, echocardiograms were performed regularly during a 1-year follow-up.

Results: Seventeen patients (33%) had persistently increased NT-proBNP, 19 patients (36%) had only transient increases (concentrations went back to baseline at 72 h), and 16 (31%) had no increases [mean (SD) values at 72 h, 1163 (936) ng/L vs 185 (101) ng/L vs 39 (19) ng/L, respectively; P <0.0001]. Only patients with persistently increased NT-proBNP had a significant worsening of the left ventricular diastolic indexes from baseline to 12 months [ratio of peak early to peak late flow velocities from 1.42 (0.33) to 0.78 (0.11); P <0.0001; isovolumetric relaxation time from 90 (15) to 141 (26) ms; P <0.0001; E-wave deceleration time from 162 (17) to 224 (32) ms; P = 0.0004] and of the left ventricular ejection fraction [from 62.8 (3.4)% to 45.6 (11.5)%; P <0.0001].

Conclusions: Persistently increased NT-proBNP early after administration of HDC is strongly associated with development of cardiac dysfunction. This finding has important implications for identifying patients at risk of developing chemotherapy-induced cardiotoxicity.

The following articles in journals at HighWire Press have cited this article:

				M. Emdin, S. Vittorini, C. Passino, and A. Clerico Old and new biomarkers of heart failure Eur J Heart Fail, April 1, 2009; 11(4): 331 - 335. [Abstract] [Full Text] [PDF]

				L. Gianni, E. H. Herman, S. E. Lipshultz, G. Minotti, N. Sarvazyan, and D. B. Sawyer Anthracycline Cardiotoxicity: From Bench to Bedside J. Clin. Oncol., August 1, 2008; 26(22): 3777 - 3784. [Abstract] [Full Text] [PDF]

				B. M. P. Aleman, A. W. van den Belt-Dusebout, M. L. De Bruin, M. B. van 't Veer, M. H. A. Baaijens, J. P. d. Boer, A. A. M. Hart, W. J. Klokman, M. A. Kuenen, G. M. Ouwens, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma Blood, March 1, 2007; 109(5): 1878 - 1886. [Abstract] [Full Text] [PDF]